A 32 year old patient complains about heartburn and dull pain in the epigastrium that appear 2-3 hours after meal. Exacerbations happen in spring and in autumn. The patient has food intolerance of eggs and fish. Objectively: stomach palpation reveals painfulness in the gastroduodenal area. Electrophasoduodenoscopy revealed a 5 mm ulcer on the anterior wall of duodenum. Urease test is positive. What is the most probable leading mechanism of disease development?

Correct Answer: A

Rationale: The correct answer is A: Helicobacterial infection. This is the most probable leading mechanism of disease development in this case because the patient's symptoms, such as heartburn, epigastric pain, food intolerance, and presence of a duodenal ulcer with a positive urease test, are classic signs of Helicobacter pylori infection. This bacterium colonizes the stomach lining, leading to inflammation and ulcer formation. The exacerbations in spring and autumn could be due to seasonal variations in immune response. Choice B: Dietary allergy is incorrect because the symptoms and findings in the patient are more indicative of an infectious etiology rather than an allergic reaction to specific foods. Choice C: Autoantibody production is unlikely as there are no indications of an autoimmune process in this case. Choice D: Reduced prostaglandin synthesis is not the leading mechanism as the symptoms and findings are more consistent with an infectious cause rather than a deficiency in prostaglandin synthesis.

Correct Answer: A

Rationale: Osmosis is the correct answer because it is the process by which water molecules move across a semi-permeable membrane from an area of low solute concentration to an area of high solute concentration. This movement occurs passively, driven by the concentration gradient. Facilitated diffusion (B) involves the transport of specific molecules with the help of carrier proteins, not water. Phagocytosis (C) is a process where cells engulf solid particles, not water molecules. Exocytosis (D) is the process of releasing substances from a cell by fusion of vesicles with the cell membrane, not the transport of water across the membrane.

Correct Answer: D

Rationale: The correct answer is D: All are correct. Patients planned for treatment with monoclonal antibodies should be tested for HBV, HCV, and M. tuberculosis due to the risk of reactivation of these infections during treatment. HBV and HCV reactivation can lead to severe liver damage, while M. tuberculosis reactivation can cause serious respiratory complications. Testing for all three infections helps in identifying and managing any pre-existing infections to ensure patient safety during monoclonal antibody treatment. Choices A, B, and C are incorrect because each of these infections presents specific risks that need to be assessed before initiating monoclonal antibody therapy.

Correct Answer: A

Rationale: The correct answer is A: Clostridium botulinum. This bacterium is known for producing botulinum toxin, which causes botulism. It is an anaerobic, spore-forming bacterium commonly found in soil. Clostridium tetani causes tetanus, not botulism. Staphylococcus aureus can cause food poisoning but not botulism. Neisseria gonorrhoeae is responsible for gonorrhea, not botulism. Therefore, A is the correct answer due to the specific association of Clostridium botulinum with botulism toxin production.

Correct Answer: A

Rationale: The correct answer is A: Carbenicillin disodium. Carbenicillin is a semisynthetic penicillin that has marked activity against Pseudomonas aeruginosa. This is due to its extended spectrum of activity and increased stability against beta-lactamases produced by Pseudomonas aeruginosa. Carbenicillin is commonly used to treat infections caused by this bacterium. Choice B: Benzylpenicillin (Penicillin G) has limited activity against Pseudomonas aeruginosa. Choice C: Methicillin is not effective against Pseudomonas aeruginosa. Choice D: Oxacillin also has limited activity against Pseudomonas aeruginosa. In summary, Carbenicillin is the correct choice due to its marked activity against Pseudomonas aeruginosa compared to the other penicillins listed.